Provider Demographics
NPI:1588804488
Name:DARTT, RAQUEL LYN (RN)
Entity Type:Individual
Prefix:MS
First Name:RAQUEL
Middle Name:LYN
Last Name:DARTT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 SOUTH ALMA SCHOOL RD.
Mailing Address - Street 2:SUITE 160
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-3003
Mailing Address - Country:US
Mailing Address - Phone:480-831-7566
Mailing Address - Fax:
Practice Address - Street 1:2770 EAST VAN BUREN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008
Practice Address - Country:US
Practice Address - Phone:602-273-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN126959163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse